PEDIATRIC EMERGENCIES Sandra Horning, MD Sacred Heart Medical Center Emergency Department

Transcription

1 PEDIATRIC EMERGENCIES Sandra Horning, MD Sacred Heart Medical Center Emergency Department Overview Roles of the EMS in Pediatric Care Growth and Development Assessment Airway Adjuncts and Intravenous Access Medical Emergencies Child Abuse and Neglect Role of EMS Pediatric Care Pediatric injuries have become major concerns. Children are at higher risk of injury than adults. Children are more likely to be adversely affected by the injuries they receive. Pediatric Advanced Life Support (PALS) Continuing Education and Training Pediatric Education for the Prehospital Provider (PEPP) 1

2 Responding to Patient Needs The child s most common reaction to an emergency is fear of: Separation Removal from a family place Being hurt Being mutilated or disfigured The unknown Responding to Parents or Caregivers Communication! One EMT speaks with the adults. Introduce yourself and appear calm. Be honest and reassuring. Keep parents informed. Toddlers Ages 1 to 3 years. Great strides in motor development. May stray from parents more frequently. Parents are the only ones who can comfort them. Language development begins. Approach child slowly. Toddlers continued Examine from head-to-toe. Avoid asking yes or no questions. Allow child to hold a favorite blanket or item. Tell child if something will hurt. 2

3 Preschoolers Common Preschooler Illnesses Ages 3 to 5 years. Increase in fine and gross motor skills. Children know how to talk. Fear mutilation. Seek comfort and support from within home. Distorted sense of time. Croup Asthma Poisoning Auto accidents Burns Child abuse Ingestion of foreign bodies Drowning Epiglottitis Febrile seizures Meningitis School-Age Children Common Illness and Injuries in School-Age Children Ages 6 12 years. Active and carefree age group. Growth spurts are common. Give this age group responsibility of providing history. Respect modesty. Drowning Auto accidents Bicycle accidents Falls Fractures Sports injuries Child abuse Burns 3

4 Adolescents Ages 13 to 18. Begins with puberty, which is very childspecific; are very body conscious. May consider themselves grown up. Desire to be liked and included by peers. Are generally good historians. Relationships with parents may be strained. Common Adolescent Illness and Injuries Mononucleosis Asthma Auto accidents Sports injuries Drug and alcohol problems Suicidal gestures Sexual abuse Basic Considerations Much of the initial patient assessment can be done during visual examination of the scene. Involve the caregiver or parent as much as possible. Allow to stay with child during treatment and transport. History Nature of illness/injury Length of time ill or injured Presence of fever Effects of illness/injury on behavior Bowel/urine habits Presence of vomiting/diarrhea Frequency of urination 4

5 Focused or Head-to-Toe Exam Pupils Capillary refill Hydration Pulse oximetry Respiratory Emergencies Infections Upper airway distress Croup Epiglottitis Lower airway distress Asthma Bronchiolitis Croup and Epiglottitis Croup An inflammatory process of the upper respiratory tract involving the subglottic region. Ages 6 months to 4 years of age. Occurs mostly in the middle of the night, usually without prior upper respiratory infection. During late fall and early winter. 5

6 History of upper respiratory infection for 1-2 days. Assessment Respiratory stridor due to subglottic edema. Possibly wheezes. Characteristic barking (seal or dog-like) or brassy cough due to edema of the vocal chords. hoarseness Fever usually low grade. Consider ALS Airway. Management Oxygen. Have the parent assist with oxygen. Consider BVM. Monitor vital signs Rapidly forming swelling of the epiglottis and its surrounding Epiglottitis structures. Most commonly in children 3-7 years old. Bacterial infection, usually Hemophilus influenza type B. More limited due to H-flu vaccine. Child appears agitated or in respiratory failure. Epiglottitis A true emergency because the child can progress to complete airway obstruction and respiratory arrest if the epiglottis swells over the opening of the trachea. 6

7 Signs of respiratory Distress. A quiet child. Assessment Working very hard to keep breathing. Sitting upright, leaning forward, neck extended forward (tripod position). Mouth open, tongue protruding (drooling). Painful swallowing. Febrile. Assessment Muffled voice and stridor may be present. Toxic appearance. In severe cases, by hypoxic. Consider ALS High flow oxygen, Management cool mist O2 if available, Non-Rebreather Mask if the patient will tolerate or blow-by. NEVER ATTEMPT TO VISUALIZE Asthma/Bronchiolitis Bronchospasm, excessive mucous production, inflammation of the small airways. Typically in child with Hx of asthma. Triggered by upper respiratory infections, allergies, changes in temperature, physical exercise, emotional response. A silent chest means danger!! 7

8 Signs of Respiratory distress Expiratory Significant wheezes. findings Tachypnea with prolonged expiratory phase. Trigger. Bronchiolitis and asthma may present similarly, however, Albuterol will not improve bronchiolitis but it will also not harm patient Consider ALS Oxygen by most Management effective method. BVM, ETT (if Airway Tech or EMT-P is available) Obtain vascular access. IV (if ILS or ALS is available) Second leading cause of death in infants < 6 months of Child age. Abuse each year. Physically or mentally handicapped person < 21 years. The Abuser Parent, legal guardian, foster parents. Person, institution, agency or program having custody of the child. Caretaker..baby-sitter. 8

9 The stigmata of child abuse Infants and Children with Special Needs Common home-care devices Tracheostomy tubes Apnea monitors Home artificial ventilators Central intravenous lines Gastric feeding and gastrostomy tubes Shunts Questions? REVIEW TEST ANSWERS 9

10 Contact: Renée Anderson Fax: